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Background Trends in breast cancer mortality in the United States are decreasing, but racial disparities persist. Using an implementation science framework to inform evidence-based breast cancer screening and navigation within federally qualified health centers (FQHCs) with community stakeholders can mitigate barriers to screening. Methods Using an integrated theoretical framework of the Practical, Robust Implementation and Sustainability Model and the Social Ecological Model, the University of Illinois Cancer Center and Mile Square Health Centers (MSHC) FQHC developed a breast cancer screening and navigation program, known as the Mile Square Accessible Mammogram Outreach and Engagement (Mi-MAMO) program, to tackle breast cancer disparities in Chicago among underresourced communities. To increase access to screening, patient navigators conducted community outreach activities. Partnerships were forged with community-based organizations, health care systems, and insurers. Outcomes were monitored with standardized performance measures. Results Between January and December 2017, 103 women received a screening mammogram at MSHC. To increase screening rates, Mi-MAMO was started in August 2017. Between January and December 2018, the number of women who received a screening mammogram increased to 567. From August 2017 to December 2018, 779 women received navigation to screening and/or diagnostic services through the Mi-MAMO program. The majority of women were uninsured (63.9%), and 95.5% were racial/ethnic minorities. Twenty-four percent (n = 185) completed diagnostic services, and 10 women received positive breast cancer diagnoses (mean age, 49.7 years); all successfully navigated to treatment. The Mi-MAMO program is ongoing. Conclusions Deploying an integrated framework for patient navigation programs can increase breast cancer screening utilization and awareness among underresourced populations at higher risk for breast cancer.

PURPOSE: Here we aim to review the association between mammographic density, collagen structure and breast cancer risk. FINDINGS: While mammographic density is a strong predictor of breast cancer risk in populations, studies by Boyd show that mammographic density does not predict breast cancer risk in individuals. Mammographic density is affected by age, parity, menopausal status, race/ethnicity, and body mass index (BMI). New studies normalize mammographic density to BMI may provide a more accurate way to compare mammographic density in women of diverse race and ethnicity. Preclinical and tissue-based studies have investigated the role collagen composition and structure in predicting breast cancer risk. There is emerging evidence that collagen structure may activate signaling pathways associated with aggressive breast cancer biology. SUMMARY: Measurement of film mammographic density does not adequately capture the complex signaling that occurs in women with at-risk collagen. New ways to measure at-risk collagen potentially can provide a more accurate view of risk.

Current public health problems such as cancer have an expansive set of lifestyle and social circumstances that affect the cause and course of the disease. In response, over the past 7 years, the National Cancer Institute (NCI) has recognized the important role that cancer centers play in their community and has gradually increased the requirements and stringency of these sections in the Cancer Center Support Grant guidelines to include a plan for community outreach and engagement. Developing sustainable community-academic partnerships is an essential factor for the successful dissemination and implementation of promising interventions and programs aimed at decreasing barriers and improving cancer outcomes. Understanding how best to facilitate linkages and collaboration can expedite translation of research knowledge into practice and allow more evidence-based improvements to be implemented into practice as well as influence research agendas. This article will examine several examples of successful community-academic partnerships focused on cancer prevention and control and explore lessons learned.

BACKGROUND: The Mammography Quality Standards Act (MQSA) requires that mammography facilities conduct an audit but there are no specifications on the metrics to be measured. In a previous mammography quality improvement project, we examined whether breast cancer screening facilities could collect the data necessary to show that they met certain quality benchmarks. PURPOSE: Here we present trends from the first five years of data collection, to examine whether continued participation in this quality improvement program was associated with an increase in the number of benchmarks met for breast cancer screening. MATERIALS AND METHODS: Participating facilities across the state of Illinois (N=114) with at least two time points of data collected in (years 2006, 2009, 2010, 2011 and/or 2013) were included. Facilities provided aggregate data on screening mammograms and corresponding diagnostic follow-up information, which was used to estimate 13 measures and corresponding benchmarks for patient tracking, callback, cancer detection, loss to follow-up and timeliness of care. RESULTS: The number of facilities able to show that they met specific benchmarks increased with length of participation for many but not all measures. Trends towards meeting more benchmarks were apparent for cancer detection, timely imaging, not lost at biopsy, known minimal status (p

Social epigenomics measures the mechanisms through which place and context change our biology. Big data science connects, analyzes, and allows inferences from previously disconnected data. Precision medicine promises individually-tailored treatments. Together, these emerging fields are changing the way we discover, decipher, and deliver new science to populations. However, differential participation in and uptake (by adopter type-from innovators to laggards) of the discovering, deciphering, and delivering of these new mechanisms may exacerbate health disparities. Innovators and early adopters are generally from higher-resourced environments. This leads to data and findings biased towards those environments. Such biased data in turn continue to be used to generate new discoveries, further obscuring potentially underrepresented populations, and creating a nearly inescapable cycle of health inequity. We argue that equitable access to representative data is of special moral (bioethical) importance, necessary to break the cycle of health inequities.

We compared the performance characteristics of 297,629 full field digital (FFDM) and 416,791 screen film mammograms (SFM). Sensitivity increased with age, decreased with breast density, and was lower for more aggressive and lobular tumors. While sensitivity did not differ significantly by modality, specificity was generally 1–2 percentage points higher for FFDM than for SFM across age and breast density categories. The lower recall rate for FFDM vs. SFM in our study may partially explain performance differences by modality. In this large healthcare organization, modest gains in performance were achieved with the introduction of FFDM as a replacement for SFM.

Compared to non-Latina (nL) white women, nL black women are diagnosed with more aggressive breast cancers, which in turn should be more likely to go undetected on screening mammography and subsequently arise as interval breast cancer (IBC). We sought to estimate the extent of an anticipated racial disparity in IBC within a single, large health care organization.The present analysis focuses on 4357 breast cancers diagnosed between 2001 and 2012 and within 18 months of a screening mammogram (N = 714,218). We used logistic regression with model-based standardization (predictive margins) to estimate adjusted prevalence differences corresponding to a racial disparity in IBC.Overall, prevalence of IBC within 18 months was 20.7%. Contrary to expectation, in patient-adjusted models, there was no IBC racial disparity (percentage point disparity = -2.1, 95% confidence interval: -4.7, 2.6). However, when controlling for facility characteristics, including proportion of nL black patients, the model coefficient for the IBC disparity reversed sign and changed substantially (P .0001) and a racial disparity emerged (percentage point disparity = +5.1, 95% confidence interval: -0.3, 9.9).The sorting of patients by race across facilities appears to have mitigated an otherwise anticipated disparity in IBC. Possible explanations are discussed.

To address locally relevant cancer-related health issues, health departments frequently need data beyond that contained in standard census area-based statistics. We describe a geographic information system-based method for calculating age-standardized cancer incidence rates in non-census defined geographical areas using publically available data. Aggregated records of cancer cases diagnosed from 2009 through 2013 in each of Chicago’s 77 census-defined community areas were obtained from the Illinois State Cancer Registry. Areal interpolation through dasymetric mapping of census blocks was used to redistribute populations and case counts from community areas to Chicago’s 50 politically defined aldermanic wards, and ward-level age-standardized 5-year cumulative incidence rates were calculated. Potential errors in redistributing populations between geographies were limited to

Background: The utilization of non-cancer-related screening tests may result in a screening-related comorbidity that also serves as a marker for overall increased preventive health care use, including for breast cancer detection. Previous studies have found that a diagnosis of either hypertension or cholesterol has been associated with earlier stage at diagnosis for breast cancer. We sought to replicate these findings in a racially and ethnically diverse sample of patients in the population-based Breast Cancer Care in Chicago (BCCC) study. Methods: Participants included 989 non-Hispanic White (NHW), African American (AA), and Hispanic female breast cancer patients diagnosed between 2005 to 2008 who completed an interview. All patients resided in Chicago, Illinois, and were between the ages of 30-79 years at the time of their first primary in situ or invasive breast cancer diagnosis. Comorbid conditions were defined from interviews and medical record abstractions. Multivariable logistic regression and Cox proportional hazards (PH) models were used to estimate the associations of comorbid conditions with mode of detection (screen-detected vs. symptomatic), breast cancer-specific survival (BCSS), and overall survival (OS). Results: Overall, 33% of BC patients had hypertension and 9% had high cholesterol (HC). A diagnosis of hypertension was not associated with mode of breast cancer detection or survival. Screen-detection was nearly 30 percentage points higher for patients with vs. without a diagnosis of HC (78% vs. 49%, PD=0.29, 95% CI: 0.19, 0.39). HC was present in 9% of NHW BC patients and 8% of AA and Hispanic BC patients. The association of HC with screen-detection varied widely by race/ethnicity, being strongest among AA patients (PD=0.41, 95% CI: 0.28, 0.54), more moderate for NHW patients (PD=0.27, 95% CI: 0.14, 0.40), and absent among Hispanic patients (PD=0.05, 95% CI: -0.21, 0.31). With adjustment for age, race/ethnicity, income, education, affluence, disadvantage, insurance status, presence of a regular provider, and time of last clinical breast exam and last mammogram, HC remained associated with screen-detection (PD=0.21, 95%CI: 0.10, 0.32). A diagnosis of high cholesterol was associated with a large but imprecise reduction in age-adjusted BCSS (HR=0.43, 95% CI: 0.14, 1.3) and OS (HR=0.50, 95% CI: 0.21, 1.1). Multivariable-adjusted HRs were 0.54 (95% 0.17, 1.7) and 0.55 (0.24, 1.2), respectively. Conclusion: High cholesterol may be a potent marker for contact with a primary care physician and willingness to utilize preventive services. We found a particularly strong association of high cholesterol with early detection among AA patients. This association remained after robust control for preventive breast health care variables, suggesting that it is an independent predictor of screen-detected BC. A larger study is required to have sufficient sample to examine subsequent associations with BCSS and OS among racial/ethnic subgroups. Citation Format: Alpana Kaushiva, Susan Hong, Katherine Tossas-Milligan, Garth Rauscher. Influence of cholesterol screening on breast cancer detection and survival in the Breast Cancer Care in Chicago Study [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B112.

Background: Cervical cancer outcomes are influenced by race, socioeconomic status and region. African American women have the highest mortality rate from cervical cancer and Hispanic and American Indian/Alaska Native women have the highest cervical cancer incidence rates among racial/ethnic groups. Disparities in cervical cancer can be greatly improved by increasing access to and awareness of Pap screening and HPV vaccination among vulnerable populations. Safety net and community hospitals offer broader opportunities to reach at-risk individuals, however these hospitals face many challenges that mirror those of the patients they serve, including: decreased access to innovative research and treatment, decreased access to the full range of specialty care, and funding challenges. Public-Public partnerships between academic medical centers, cancer centers and private service organizations that extend to safety net and community hospitals can increase cervical cancer screening rates among individuals at greatest risk. Methods: The Loretto Hospital and Norwegian American Hospital serve communities that suffer the highest cervical cancer mortality rates in Chicago. Funded by the Bristol Myers Squibb Foundation, the University of Illinois Cancer Center partnered with these two community hospitals located on the west sides of Chicago to increase cervical cancer screening rates through clinical and community patient navigation. Evidence based methods such as small media interventions, client reminders, and one-on-one education will also be used to increase screening awareness and education. The evidence-based, implementation science program is guided by the RE-AIM framework. Reach, adoption and sustainability will be maximized through the integration of community hubs that comprise faith-, community-, school-based organizations and policy makers. Results: The project is a three year project. Now in its pre-implementation phase, the program is currently piloting data instrumentation and implementation processes. Preliminary results will be presented at the meeting. The Partnership development phase has been achieved and Full implementation will begin August 2019. Conclusion: It is expected that building partnerships between large academic medical centers, cancer centers and community hospitals will increase the capacity of community hospitals to offer quality screening and specialized care to community members and increase access to cervical cancer screening and education among at-risk populations ultimately decreasing cervical cancer disparities among underserved populations in the University of Illinois Cancer Center catchment. Citation Format: Vida Henderson, Jessica Madrigal, Jeanette Gonzalez, Erica Martinez, Katherine Tossas-Milligan, Patricia Doykos, Karriem Watson, Robert Winn. Building sustainable partnerships between cancer centers and safety net community hospitals to increase access to and quality of cancer care [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr A128.

Background As detection and treatment for breast cancer in the United States have improved, racial and ethnic disparities persist. Utilizing an implementation science framework to inform an evidence-based breast cancer screening and navigation program within Federally Qualified Health Centers (FQHCs) with community stakeholders can mitigate multiple barriers to breast cancer screening. Methods Utilizing an integrated theoretical framework of the Practical, Robust Implementation and Sustainability Model (PRISM) and the social ecological model (SEM), the University of Illinois Cancer Center, University of Illinois Hospital & Health Sciences System (UI Health) including Mile Square Health Centers (MSHC) FQHC, and the Chicago Department of Public Health (CDPH) developed a breast cancer screening and navigation program to tackle breast cancer disparities in Chicago among under-resourced women, known as the Mi-MAMO program. To increase access to screening services, patient navigators conducted community outreach and engagement activities. Program partnerships were forged with community-based organizations, healthcare systems and insurers. Program outcomes were monitored using standardized performance measures. Results Between January-December 2017, 103 women received a screening mammogram at MSHC. To increase screening rates, the Mi-MAMO program was started in August 2017. Between January-December 2018, the number of women who received a screening mammogram at MSHC increased to 1051. From August 2017 (start of program) to December 2018, 779 women received navigation to screening and/or diagnostic services through the Mi-MAMO program. The majority of women were uninsured (63.9%) and 95.5% were racial/ethnic minorities. Twenty-four percent (n=185) of women completed diagnostic services and ten women received positive breast cancer diagnoses (mean age 49.7 years). All diagnosed women were successfully navigated to treatment. The Mi-MAMO program is on-going. Conclusion Deploying an integrated framework that merges an implementation science and multi-level behavioral health framework for patient navigation programs has the potential to increase breast cancer screening utilization and awareness among under-resourced populations who may be at higher risk for breast cancer. Citation Format: Vida A Henderson, Katherine Tossas-Milligan, Erica Martinez, Barbara Williams, Paola Torres, Nasima Mannan, Lauren Green, Beti Thompson, Robert Winn, Karriem S Watson. Implementation of an integrated framework for a breast cancer screening and navigation program for under-resourced women [abstract]. In: Proceedings of the Twelfth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2019 Sep 20-23; San Francisco, CA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl_2):Abstract nr C110.

Background: Non-Latina (nL) black women are diagnosed at later stages and with more aggressive forms of breast cancer than their nL white counterparts, including higher-grade tumors and those that lack estrogen and progesterone receptors (ER/PR negative). High breast density (HBD) is a strong risk factor for a late-stage breast cancer diagnosis among women undergoing mammography screening, yet nL black women are slightly less likely to have dense breasts according to the standard clinical classification method. We previously found that after adjusting for differences in obesity using body mass index (BMI), nL black women were substantially more likely to have dense breasts compared to nL white women. Dense breast tissue can mask tumors and cause them to go undetected at screening, only to arise later as a lump, discovered symptomatically when they later stage. It is also conceivable that dense breast tissue could predispose women to develop more aggressive breast cancers that grow more rapidly, are more likely to arise between screens as “true interval” cancers, and therefore might be detected with more frequent screening. We used path analysis (or structural equations modeling, SEM) to estimate the separate contributions of tumor masking and tumor aggressiveness in mediating HBD's associations with later stage, overall and by race. Methods: We used data on 4691 women from the Metropolitan Chicago Breast Cancer Registry, aged 40-79, and diagnosed at stages 1 (early), 2,3 or 4 (later), between 2001 and 2013. Breast density was obtained from the screening mammogram preceding diagnosis. Mode of detection was defined dichotomously as symptomatic versus screen detected. Path analysis (conducted in Mplus) was used to estimate the age, race, and BMI adjusted, direct and indirect effects of HBD on stage at diagnosis. Because estimates can vary depending on model assumptions, we ran simultaneous linear regression models and also ran simultaneous ordered probit regression models. In both sets of models we estimated the relative contributions of tumor masking and tumor aggressiveness in transmitting the association of HBD with stage at diagnosis. Results: A one-unit increase in BD was associated with a 9-percentage-point increased prevalence of later stage (stage 2,3,4, vs. 1) at diagnosis. Roughly one third of the HBD, later-stage association could be explained by tumor masking, and virtually none of the association could be explained by tumor aggressiveness. Similar results were obtained for linear and ordered probit models. Results were broadly similar for nL black and nL white women. Conclusion: Ours is the first analysis we are aware of to formally confirm via mediation analyses that tumor masking is the primary process through which women with dense breasts are disproportionately diagnosed at later stages. To reduce opportunities for tumor masking, women with dense breasts are often referred for supplemental/advanced imaging with breast MRI, ultrasound, or (increasingly) tomosynthesis. We think it is likely that the current criteria for referring women for advanced imaging based on breast density may contribute to racial disparities because (1) they do not account for the greater prevalence of more aggressive breast cancer in nL black patients, and (2) they do not account for the disproportionate prevalence of obesity among nL black women, which may obscure the usefulness of the usual clinical classification method of BMI in making referrals for supplemental imaging. Citation Format: Katherine Y. Tossas-Milligan, Garth H. Rauscher, Richard Campbell, Victoria Seewaldt. Tumor masking or tumor aggressiveness? A structural equations modeling approach to estimate the impact of breast density on breast cancer stage, overall and by race [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr PR08.

Background: African American (AA) women were until recently less likely to be diagnosed with breast cancer (BC) and remain more likely to die from the disease when compared to non-Latina (nL) White (White) counterparts. High mammographic breast density (HBD) is a well-established risk factor for developing BC, but there is no consensus in the literature regarding whether HBD varies by race/ethnicity (R/E). AA women have been reported to have lower breast density compared to nL Whites, Latinas and Asians in some but not all studies. Only a handful of studies have examined factors (e.g. BMI, age, parity, hormone therapy, menarche and menopause) that might account for racial/ethnic differences in HBD. Therefore, we endeavored to examine racial/ethnic differences in HBD and the potential role of socioeconomic status (SES), obesity and parity in observed racial/ethnic differences in a large cohort of women undergoing screening mammography. Methods: We used data on 133,983 women aged 40-79 undergoing their most recent screening mammogram between 2001 and 2015 within a large healthcare organization and whose R/E was nL White, nL Black, Latina, Native American, or Asian/Pacific Islander (Asian). At the screening mammogram, each breast received a breast density score from the interpreting radiologist using the American College of Radiology Breast Imaging Reporting and Data System (BIRADS 1-4), defined as fatty (BIRADS 1), scattered fibroglandular (BIRADS 2), heterogeneously dense (BIRADS 3) or extremely dense (BIRADS 4). We defined breast density as the maximum value of the two breast density scores. We defined HBD as a breast density BIRADS score of 3 or 4 (versus 1 or 2). SES was defined by creating two census-tract level, aggregate variables for disadvantage and affluence. Body mass index (BMI) was defined from patient reported height and weight. Women also reported their number of live-births (parity) and menopausal status. HBD was modeled in logistic regression with model-based standardization (predictive margins) to estimate age-adjusted prevalence of HBD by R/E, before and after including patient factors in the model that might explain R/E differences in HBD. Results: Lower BMI, lower parity, and higher socioeconomic status were each associated with HBD in all analyses (p Citation Format: Katherine Y. Tossas-milligan, Firas Dabbous, Therese Dolecek, Teresita Macarol, William Summerfelt, Garth Rauscher. Patient risk factors for high mammographic breast density and their contributions to ethnic differences in breast density. [abstract]. In: Proceedings of the Ninth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2016 Sep 25-28; Fort Lauderdale, FL. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2017;26(2 Suppl):Abstract nr PR09.

Background: It is well established that Non Latina (nL) Black patients are more likely than nL white (white) patients to be diagnosed with more aggressive forms of breast cancer. In addition, prior population-based research conducted in Chicago suggests that black women tend to be screened at lower resource facilities, and may also have screening images of lower quality and be more likely to have their breast cancer missed at interpretation. Consistent with all of these observations, black patients were more likely to report symptomatic awareness of their breast cancer despite a recent asymptomatic screening mammogram in the Breast Cancer Care in Chicago study. Therefore, black women may be more likely than their white counterparts to have a breast cancer diagnosis following a negative screen (so-called interval breast cancer). METHODS: The goal of the present study was to examine potential disparities in interval breast cancer (IBC) using data from approximately 30 mammography sites (including 8 hospital-based sites) within a single large health care organization in metropolitan Chicago. Methods: A screening mammogram was defined as a bilateral mammogram with a description of screening in the radiology database, in women without a prior history of breast cancer, mastectomy, or breast implants, and without any imaging in the 9 months prior to the screen. We linked 761,908 screening examinations conducted between 2001-2010 to breast cancer incidence data from the Illinois state cancer registry, using probabilistic methods. After excluding other race/ethnicities for this analysis, we identified 4829 breast cancers diagnosed between 2001 and 2011 and within 12 months of a screen. An interval breast cancer was defined as a breast cancer diagnosed within 12 months of a negative screening mammogram (BIRADS 1,2). IBC was modeled in logistic regression with generalized estimating equations (to account for multiple screens per woman) while adjusting for age, parity, breast density, race, family history, parity and exam year, ER status, tumor grade, and individual screening facility as covariates. Of the 31 facilities with data, 18 smaller screening facilities with less than 20 associated breast cancer diagnoses were collapsed into a single category. Model-based standardization (predictive margins) was used to estimate adjusted prevalence differences (PDs) in IBC from the logistic regression models, and 95% bias-corrected bootstrap confidence intervals were obtained (1000 replications). Results: Before adjusting for mammography site, black patients were, contrary to expectation, less likely to experience an IBC than white patients (1.36 vs. 1.83 per 1000 screens, adjusted Rate Difference or RD = - 0.47 per 1000 screens, p Conclusion: In this large healthcare organization, we observed a reverse disparity such that white patients were more likely than their black counterparts to experience an IBC, but the association disappeared when we took mammography site into account in the analysis. These results suggest that higher quality mammography screening resources are more widely accessible to black than white patients within this organization. Larger volume facilities within this organization tend to be located in urban areas with higher proportions of black women, whereas smaller standalone facilities tend to be located in the suburbs where there are a higher proportion of white women. These standalone facilities may be less likely to employ breast imaging specialists and less likely provide multimodality breast imaging in a multidisciplinary setting, and these differences may be contributing to differential access to quality screening that benefits black women. The larger implication of these findings is that at a population level, racial disparities in breast cancer could perhaps be ameliorated or even eliminated if resources were disproportionately made more available to black women. In order to overcome breast cancer disparities and create true equity in care, disproportionate resource allocation solutions may be necessary. This abstract is also presented as Poster C61. Citation Format: Garth H. Rauscher, Firas Dabbous, Terry Dolecek, Terry Macarol, Katherine Tossas-Milligan, Jenna Khan, Sarah Friedwald, Wm. Thomas Summerfelt. A reverse, racial disparity with respect to interval breast cancer rates within a large healthcare organization has implications for eliminating disparities more generally. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr PR03.

Background: Non-Latina Black (black) women, despite their lower BC incidence, are more likely to die from breast cancer compared to their nL White (white) counterparts. While differential access to care, comorbidities and BC aggressiveness are potential contributors to this difference, the potential impact of HMD on this disparity has rarely been explored. For example, nL black women are disproportionately diagnosed with more aggressive tumors that lack estrogen and progesterone receptors (ER and PR) and that are high grade. Therefore, if the association of HMD with breast cancer incidence varied by tumor subtype this could have implications for disparities in breast cancer aggressiveness and subsequent outcomes. Most of the conclusions establishing high mammographic breast density (HMD) as a risk factor for increased breast cancer incidence are derived from studies conducted primarily in whites, which jeopardizes generalizability. We sought to estimate the association between HMD and breast cancer incidence separately for white and black women and by tumor subtype, using data from a single, large healthcare organization. Methods: We used data from screening mammograms performed in women ages 18-100, between 2001 and 2010, probabilistically linked to incident BC cases recorded in the Illinois State Cancer Registry (ISCR) during 2001-2011. Each screening mammogram received a breast density score from the interpreting radiologist using the American College of Radiology Breast Imaging Reporting and Data System (BIRADS 1-4), defined as fatty (BIRADS 1), scattered fibroglandular (BIRADS 2), heterogeneously dense (BIRADS 3) or extremely dense (BIRADS 4). A mean BIRADS breast density score was calculated using available scores from both breasts at each exam. The mean was dichotomized as high (mean BIRADS score > 2.5) versus low (mean BIRADS score ≤2.5) and the dichotomous variable was modeled in logistic regression with generalized estimating equations (to account for multiple screens per woman) to estimate the association between breast density and the probability of a breast cancer diagnosis within 12 months of the screen. Models included age, race, family history, parity and exam year as covariates, and separate models were estimated for black and white women. Odds ratios were interpreted as rate ratios (RR) due to the rarity of the outcome ( Results: Included in this analysis were 616,466 screens on 201,348 white or black women during 2001-2010, and 4,104 BC in 3,706 women during 2001-2011 (overall rate of 6.7 per 1000 screens, 6.7 for whites and 6.5 for blacks, p=0.21). There were disparities in the distribution of tumor subtypes: breast cancers diagnosed in black women were more likely to be ER negative (23% vs. 15%, p Discussion: Our findings reiterate high breast density as a risk factor for breast cancer incidence. In addition, we found that the association was of roughly equal magnitude among white and black women, and of roughly equal magnitude for ER negative and ER positive tumors. The stronger association of HMD with high grade tumors, however, implies that HMD may be a more detrimental risk factor for black women who are more likely to experience higher grade tumors than white women. Citation Format: Katherine Y. Tossas-Milligan, Firas Dabbous, Garth Rauscher. Is the influence of high mammographic breast density on breast cancer incidence the same for non-Latina black and white women? [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr C43.

Backround: In 2007, the Metropolitan Chicago Breast Cancer Taskforce (The Taskforce) was initiated to identify the reasons for an alarming Black/White breast cancer mortality gap in metropolitan Chicago and to propose solutions. One hypothesis raised was that unequal access to high quality breast cancer screening and treatment care may be a significant driver of Chicago's breast cancer disparity. While there is growing interest in the role of breast cancer screening quality in explaining black/white breast cancer mortality gap, there is no research to our knowledge assessing quality measures about the breast cancer screening processes within facilities across the state of Illinois. We summarize data and report trends on 11 breast cancer screening metrics from 3 years of mammography quality data surveillance for facilities in Illinois. Methods: The Taskforce collected aggregate data on 11 breast cancer screening quality metrics for calendar years 2006, 2009, and 2011, including the number of screening mammograms that: received follow-up imaging within 30 days and 12 months; received a biopsy recommendation within 12 months of the screen; resulted in a biopsy recommendation within 12 months; resulted in a biopsy (following recommendation) within 60 days and 12 months of the screen, respectively. Finally, we requested the number of cancers diagnosed within 12 months of an abnormal screening mammogram and the number of these that were minimal and early stage cancers. Data were analyzed for the 32 facilities that submitted metrics across all 3 years. The change in the mean number of benchmarks met was estimated using linear regression using a generalized estimating equations approach with exchangeable correlation matrix and robust standard errors to account for clustering by site. At each time point 95% confidence intervals were estimated. Results: Out of 11 possible metrics, the average number of benchmarks met by each facility for 2006, 2009 and 2011 was 4.88, 7.06 and 8.09, respectively. This represented a 0.65 increase in the overall mean number of benchmarks met by calendar year (95%CI=0.44, 0.75) (or an overall 1.61 increase in the overall mean number of benchmarks met per time point, 95%CI=1.16, 1.97). With respect to individual benchmarks, the proportion of facilities able to show that they met the benchmarks increased substantially between 2006 and 2011 for many benchmarks including cancer detection rate (0.66 to 0.91, p=0.008), proportion of breast cancers diagnosed as minimal (0.28 to 0.88, p=0.0000) and early stage (0.22 to 0.66, p=0.000). Other benchmarks remained unmet by a majority of facilities despite showing substantial improvement over time. These included timely imaging within 30 days of the screen (0.28 to 0.44, p=0.077), and timely biopsy within 60 days of the screen (0.13 to 0.42, p=0.002). Discussion: The American College of Radiology recommends that facilities meet certain additional quality benchmarks above and beyond the audit requirements of the Mammography Quality Standards Act. These include measuring the proportion of abnormal screening mammograms, timeliness of follow-up, extent of screen-detection (i.e., cancer detection rate for screening mammograms), and ability to detect small and early stage tumors. To date, none of these recommendations have been incorporated into MQSA guidelines. The results of this quality improvement project show an overall improvement across time in the average number of quality benchmarks institutions can demonstrate that they meet. Much of this improvement likely stems from an increased ability to collect and report the data needed to construct these measures. Lack of timeliness of diagnostic imaging and biopsy services remain a clear shortcoming for many facilities. Citation Format: Katherine Y. Tossas-Milligan, Bethliz Irizarry, AnneMarie Murphy, Garth H. Rauscher. Trends in mammography quality benchmarks met over time: Moving beyond the Mammography Quality Standards Act to address breast cancer disparities. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B79.

Purpose: The purpose of this study was to use data collected from a recent Metropolitan Chicago Breast Cancer Task Force (MCBCTF) survey to explore racial/ethnic and socioeconomic disparities in access to screening and diagnostic services for breast cancer in Illinois and to compare equitable access to services for Chicago versus the rest of the state. Methods: Facilities that performed mammography were recruited to participate in a quality improvement project that included completing a facility survey. Participants who completed surveys received an increased mammogram reimbursement for Medicaid patients to equal the Medicare rate from the Illinois Department of Healthcare and Family Service. The survey included the following data elements: number of digital and analog machines, number of radiologists dedicated (>75% of their time) to breast imaging and number of general radiologists, number of dedicated and general mammography technicians, monthly volumes of screening and diagnostic mammograms, and whether breast ultrasound, MRI, or image-guided biopsy services were available at the site. In addition, sites reported the percentage of patients who were African-American (AA) or Hispanic, and the percentage of patients who were uninsured and on Medicaid, in categories of >10, 10-25, 25-40, 40-60, 60-75, 75-90, and >90%. Within each patient group defined by ethnicity and health insurance status, we estimated the number of screening mammograms performed separately for facilities with none, partial and sole reliance on dedicated radiologists, and separately by facility availability of breast MRI and image-guided biopsy. In all, 156 out of 359 facilities accredited by the Food and Drug Administration completed the survey, representing approximately 8.2 million screening mammograms conducted in calendar year 2012 in Illinois. Results: Overall, about 3/4 of screening mammograms were performed in nH whites and 4/5 in privately insured patients. Within the city of Chicago, 47% and 30% were performed in ethnic minorities and those without private insurance, compared to 21% and 15% in the rest of the state. Within Chicago, mammograms were more than twice as likely to be performed at facilities relying solely on dedicated radiologists when compared to the rest of the state (39% vs. 17%). In Chicago, non-Hipanic Whites were more likely than their AA and Hispanic counterparts to be screened at facilities relying solely on dedicated radiologists (50% vs. 27% and 15%, respectively) and at facilities with MRI (90% vs. 57% and 71%) and biopsy services (92% vs. 63% and 79%). In a similar manner, privately insured patients were more likely than Medicaid and uninsured patients to be screened at facilities that relied solely on dedicated radiologists (44% vs. 13% and 18%, respectively). When examining equitable access to these services for the rest of the state as a whole, very little was noted in the way of disparities by race/ethnicity or insurance status. Conclusions: Disparities in equitable access to breast cancer screening and diagnostic services exist within Chicago that are generally absent outside of the city. The concentration of academic medical centers within Chicago, while increasing access to quality breast healthcare, has also introduced racial/ethnic and socioeconomic disparities due to unequal access to these academic medical centers. Citation Format: Bethliz Irizarry, Katherine Y. Tossas-Milligan, Garth Rauscher, Anne Marie Murphy. Racial/ethnic and socioeconomic disparities in access to screening mammograms in a statewide sample of mammography facilities in Illinois. [abstract]. In: Proceedings of the Seventh AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 9-12, 2014; San Antonio, TX. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2015;24(10 Suppl):Abstract nr B84.

e12613 Background: Little is known about the extent to which radiologists actually use mammography audit reports to improve performance, or their association with attitudes or practices. As part of...

e17614 Background: In Chicago, black women are less likely to develop breast cancer compared to white women, but die from the disease at a much higher rate. One way to address this disparity is via...

151 Background: Insufficient utilization of guideline and evidence based care practices contribute to the cancer crisis (IOM 2013). We examined utilization of published breast cancer (BC) care practices and guidelines at hospitals in a large metropolitan area. Methods: IRB approved web survey of all 35 hospitals in a large metro area that provide BC treatment. Using guidelines/recommendations (NCCN, NAPBC, ADA, IOM) and peer-reviewed literature (62 studies) we developed a survey on BC care practices. Results analyzed by simple frequencies and Fisher's exact test. Results: Response rate: 91% (32/35 sites). Care practices, included in the table, are utilized by < 50% of sites. Radiation oncologist preoperative consults (53%, 8/15) and offering indicated pre-operative chemo* (67%, 10/15) are associated with 15 sites that have high volume (67+/year, Chen CS 2008) BC surgeons, compared to 17 sites without high volume BC surgeons (12%, 2/17) and (24%, 4/17) respectively, p=0.02, p=0.03. Indicated supportive services, such as a dental checkups (ADA 2008), are more likely at sites with patient-centered written treatment plans (IOM 2011) (58%, 7/12) than at sites without written treatment plans (10%, 2/20), p=0.006. Conclusions: Low utilization of published care practices and guidelines is concerning and requires attention. Other metro areas and regions should be examined as our findings indicate that patients may have limited local choices of care that is up-to-date on published guidelines and practices. [Table: see text]

207 Background: Women with personal or family history suggestive of susceptibility to hereditary breast or ovarian cancer (HBOC) should be referred to genetic assessment (USPSTF, Ann Intern Med. 2005). Women with HBOC have a 50-85% lifetime risk of breast cancer, 30-50% of breast cancer before 50 years old,15-50% lifetime risk of ovarian cancer, and 40-60% chance of developing a second breast cancer (ASCO Cancer.net HBOC 8/2013). Our goal is to examine if this almost decade old guideline is followed in breast cancer treatment and breast cancer imaging centers in a large metropolitan area. Methods: We conducted an IRB approved web survey of all 35 breast cancer treatment sites (5 academic, 21 community, 9 public or safety net) and 58 breast imaging sites (5 academic, 27 community, 26 public or safety net) in Chicago. Results were analyzed using simple frequencies and Fisher's exact test. Results: We achieved a response rate of 91% (32/35 treatment sites, 53/58 imaging sites). We found that 56% (18/32) of treatment sites have a hereditary cancer syndrome (HBOC) screening process for newly diagnosed breast cancer patients. Most of these sites, 83% (15/18), always use genetic test results in surgical decisions, as compared to 21% (3/14) of sites that do not have an HBOC screening process, p=0.0009. Only 8% (4/53) of breast imaging sites have an HBOC screening process and provide indicated patients genetic assessment information and/or referrals. While 38% (20/53) of imaging sites conduct daily internal staff discussions of hereditary risk, only 15% of them (3/20) provide genetic assessment information to indicated patients. We found no statistically significant difference between practices of academic, community, public and safety net sites. Conclusions: Breast cancer treatment sites have partial adherence to HBOC risk screening guidelines; while breast imaging sites rarely adhere to HBOC risk assessment guidelines. Consistent HBOC risk screening protocols are needed in breast cancer treatment and breast cancer imaging sites that include providing indicated patients information about, and access to, genetic assessment.